术中持续生理盐水冲洗对腰椎后路术后患者切口疼痛的影响  

Effect of continuous saline irrigation during operation on the incision pain relief after posterior lumbar surgery

作　　者：杨家祥 董连峰 高欣 刘铁龙 肖建如 Yang Jia-Xiang;Dong Lian-Feng;Gao Xin;Liu Tie-Long;Xiao Jian-Ru(Department of Orthopedics,Liu'an Hospital of Traditional Chinese Medicine,Liu'an,Anhui 237006,China;Department of Bone Oncology,Changzheng Hospital Affiliated to Navy Medical University,Shanghai 200003,China)

机构地区：[1]安徽省六安市中医院骨科,安徽六安237006 [2]海军军医大学附属长征医院骨肿瘤科,上海200003

出　　处：《解放军医学杂志》2020年第11期1151-1155,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨腰椎后路手术采用高频电刀暴露腰椎椎板过程中持续生理盐水冲洗降温对患者术后伤口疼痛的影响。方法纳入2017年8月-2018年7月海军军医大学附属长征医院因腰椎管内肿瘤接受后路腰椎管内肿瘤切除重建内固定术治疗的34例成年患者,随机分为观察组(接受持续生理盐水冲洗)与对照组(未接受持续生理盐水冲洗),每组17例。比较两组患者术中暴露出双侧椎板所需的时间,电刀周围组织的温度,肌肉组织热损伤程度,术后C反应蛋白水平,术后第1、2、3天的疼痛视觉模拟量表(VAS)评分及止痛药用量。结果观察组术中暴露出双侧椎板所需时间为(29.12±4.68)min,明显长于对照组的(24.94±3.23)min,电刀周围组织温度为(62.96±4.50)℃,明显低于对照组的(77.01±5.87)℃,差异均有统计学意义(P<0.05)。病理组织学观察显示,观察组肌肉组织热损伤程度明显轻于对照组(P<0.05)。两组术后C反应蛋白水平比较差异无统计学意义(P>0.05)。术后第1天观察组的VAS评分及止痛药用量均明显低于对照组(P<0.05),而第2、3天两组VAS评分及止痛药用量差异无统计学意义(P>0.0.5)。结论术中持续生理盐水冲洗降温可在一定程度上减轻腰椎后路手术高频电刀暴露腰椎椎板时的肌肉组织热损伤,缓解术后疼痛。Objective To explore the effect of continuous saline irrigation and cooling during posterior lumbar surgery using high-frequency electric knife to expose lumbar lamina on postoperative incision pain.Methods A total of 34 adult patients with lumbar intraspinal tumor were included in present study who received surgical treatment from August 2017 to July 2018 in Changzheng Hospital Affiliated to Navy Medical University,and were randomly divided into irrigated group(n=17)and nonirrigated group(n=17).Patients in irrigated group received continuous normal saline irrigation for cooling surgical field,while those in non-irrigated group did not receive such treatment.The time required for exposure of bilateral lamina,the temperature of tissues around the electrosurgical scalpel,degree of thermal damage of muscle tissue,postoperative C-reactive protein level,the visual analogue scale(VAS)scores at 1st,2nd and 3rd day after operation,and the amount of analgesics were compared between the two groups.Results The time required for exposure of bilateral lamina was obviously longer in irrigated group than in nonirrigated group[(29.12±4.68)min vs.(24.94±3.23)min,P<0.05],the temperature of tissues around the electrosurgical scalpel was lower markedly in irrigated group than in non-irrigated group[(62.96±4.50)℃vs.(77.01±5.87)℃,P<0.05].Histopathological observation showed that relatively mild thermal damage of muscle tissue occurred in irrigated group than in non-irrigated group,the postoperative C-reactive protein level showed no significant difference(P>0.05)between the two groups.The VAS score and the amount of analgesics were obviously lower in irrigated group than in non-irrigated group at the 1st day after operation(P<0.05),but no statistical significance(P>0.0.5)at the 2nd and 3rd day after operation.Conclusion Continuous normal saline irrigation may reduce the thermal damage of muscle tissue to some extent after posterior lumbar surgery,and relieve the postoperative pain.

关 键 词：腰椎管内肿瘤 术中冲洗 手术后疼痛 肌肉热损伤 

分 类 号：R739.43[医药卫生—肿瘤]